What are the NCCN guidelines for fine needle aspiration (FNA) and core biopsy in the treatment of breast cancer?

Updated: Feb 04, 2021
  • Author: Pavani Chalasani, MD, MPH; Chief Editor: John V Kiluk, MD, FACS  more...
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The NCCN recommends fine needle aspiration (FNA) or core biopsy for patients with any of the following characteristics:

  • Clinically node positive (3 or more positive nodes on physical exam and/or imaging) at time of diagnosis  or
  • ≥T2 or ≥N1 and with preoperative systemic therapy planned  or
  • T2–4,N1–3,M0

If FNA or core biopsy results are negative, the NCCN recommends SLNB. For those with positive results, the NCCN recommends axillary dissection I/II, although SLNB may be considered in selected cases (eg, patients with clinically negative nodes after neoadjuvant therapy).

 The NCCN guidelines state that lymph node dissection is optional in the following cases:

  • Strongly favorable tumors
  • When the result would not affect the choice of adjuvant systemic therapy
  • Elderly patients
  • Patients with comorbid conditions

Finally, for patients with clinically negative axillae who are undergoing mastectomy and for whom radiation therapy is planned, the NCCN states that axillary radiation may replace axillary dissection level I/II for regional control of disease.

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